=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215585120
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UNIVERSITY OF TEXAS RIO GRANDE VALLEY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/04/2019
-----------------------------------------------------
Last Update Date | 09/04/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1201 W UNIVERSITY DR
-----------------------------------------------------
City | EDINBURG
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78539-2909
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-665-5272
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1201 W UNIVERSITY DR
-----------------------------------------------------
City | EDINBURG
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78539-2909
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-665-5272
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL ASSOCIATE PROFESSOR
-----------------------------------------------------
Name | KERI PARCHMAN-GONZALEZ
-----------------------------------------------------
Credential | CCC-SLP
-----------------------------------------------------
Telephone | 956-458-6164
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------